Timely, appropriate fluid resuscitation increases survival rates in patients with pulmonary arterial hypertension hospitalized for sepsis
Presenter: Haidee Chen, BA, David Geffen School of Medicine at UCLA, Los Angeles, CA
Treatment and outcomes in patients hospitalized for sepsis with pulmonary arterial hypertension compared to patients without pulmonary arterial hypertension.
Pulmonary Vascular Disease Posters 1. Presented October 10, 2023.
Pulmonary arterial hypertension (PAH) may increase mortality risk among individuals who develop sepsis, results of a recent case-control study suggest. However, increased fluid resuscitation in those patients within 24 hours was associated with better outcomes, although patients who received fluids also had less severe PAH, said researcher Haidee Chen, BA, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Patients with PAH trended toward a high risk of mortality compared to age- and sex-matched control patients without PAH, according to study results that were presented during a poster session at CHEST 2023. Also, PAH patients with sepsis had significantly lower rates of fluid resuscitation and higher rates of vasopressor use compared with controls.
“While this study is retrospective and hypothesis generating, we hope it highlights the challenges of appropriate fluid resuscitation in this particularly high-risk population presenting with sepsis,” Chen said.
Sepsis, a common cause of death in PAH patients, necessitates careful fluid management and vasopressor support, according to Chen and coauthors. However, there is a dearth of data on the clinical characteristics of sepsis and treatment strategies in this acutely ill population, they noted.
For this study, the researchers conducted a retrospective analysis to investigate approaches to sepsis treatment and outcomes in patients with PAH. They included 30 patients with pre-existing PAH admitted with sepsis to 2 academic hospitals between 2015 and 2021. The group of 96 control subjects, admitted to the hospitals between 2013 and 2021, had no pre-existing PAH. Investigators used propensity score weighting by Charlson Comorbidity Index, age, and sex to balance characteristics between the case and control groups. They first identified patients using ICD-10 codes and later reviewed charts to verify the sepsis diagnoses and obtain hemodynamic variables.
Results of the study indicated a nonsignificant trend toward increased mortality in the PAH cohort, according to study authors. At 1 month, 23.3% of patients with PAH (7 of 30) had died compared to 13.5% of control patients (13 of 96; P = .376).
Treatment approaches were significantly different between groups. Control patients with sepsis but no PAH received significantly more fluid resuscitation than those with PAH (mean: 1,515 mL vs 419 mL; P < .001). Receiving increased fluids within 24 hours of admission was associated with decreased mortality in the PAH group (odds ratio 0.93; 95% confidence interval, 0.84-0.98; P = .03).
In addition, time to antibiotics was significantly longer among patients with PAH who did not receive fluid resuscitation as compared to those who did receive fluids (6.5 hrs vs 2.3 hrs, respectively; P = .04). This finding showed that patients with PAH who received fluids were more likely to get timely antibiotics, potentially indicating that sepsis was recognized earlier in those patients, investigators said in their report.
Receipt of vasoactive medications within 48 hours of admission was also significantly different between groups: 33% for patients with PAH and just 8% for controls (P = .004). Altogether, these findings suggest that select patients with PAH may benefit from early recognition of sepsis, timely antibiotics, and fluid resuscitation, Chen said.
“The takeaway is that PAH patients with sepsis are at high risk of mortality, and timely recognition of sepsis and dynamic decision-making around fluid resuscitation is crucial in this high-risk population,” she added.
Disclosures: Haidee Chen reported no relevant financial relationships related to this study.